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From: Jerry Gold
Subject: SEPI influences in psychotherapy integration
Here's a question borrowed from Ed Zuckerman, Ph.D. and which appeared
originally on the PSYUSA list:
What are the books and articles that each of us feels as having been
centrally influential in defining the ways that we think about and
practice psychotherapy? In particular, are there any writings that
opened the possibility of integration as a real one. For example,
my vision was changed forever by Paul
Wachtel's Psychoanalysis and Behavior Therapy, an experience
that I'm sure is/was shared by many? Anyone care to contribute a bibliography
of such influences? Brief annotations might be fun too.
Jerry
From: Sliepack
Brazier, D. (1995). Zen therapy: Transcending the sorrows of the
human mind. New York:Wiley.
Captures my ideas about the process and practice of therapy better
than any other book I've read...by far! In my mind a must read for
all therapists.
From: "George Bouklas"
I am sure this is something many of us can relate to, but books never
captured the essence of integration for me. I think this says something
about the written word's inability to impart much about the therapy
process. Ros and Lenny Schwartz trained us here in NY and in a two
year period brought in people from the behavioral, psychoanalytic,
psychodynamic movements and more, for marathon sessions. After we
had Ellis, we sat with someone from Esalen, then a Jungian, then a
neo-Freudian. Ros and Lenny continually asked the integrating questions,
stitching together what seemed at first disparate and contradictory.
Then I had the pleasure of observing Arnold Lazarus who brilliantly
pulled together a number of approaches. Underlying his behavioral
system was a psychoanalytic sensibility that was impossible to miss,
and this came through in a particular form of compassion for those
suffering with emotional problems. He told a story about a patient
who was criticizing herself over a certain symptom and at one point
he had exhausted behavioral remedies. But when he joined her dystonically,
that did the trick. I loved Lazarus for telling that story, because
he showed us how to merge behaviorism with psychoanalysis, right there.
Spotnitz accommodated to every kind of technique and suggested an
integrative underpinning to all our work. You had to have the "right
feelings" for the patient. The technique was secondary. I think
in this way the modern psychoanalytic movement has attracted folks
with all kinds of training, because it hunts down those ineffables,
or therapist variables that account for about half the "action"
in therapy. Probably "the book" that has most influenced
my integrative interest is "The
Book," by Alan Watts. Again, it gets at universal underpinnings
that shed light on symptoms, suffering and growth.
From: Gerald Davison
My votes are for the following:
London, P. (1964). Modes and morals of psychotherapy
Dollard & Miller (1950). Personality and psychotherapy
(Out of Stock)
Lazarus (1971). Behavior therapy and beyond
and of course
Wachtel (1977). Psychoanalysis and behavior therapy
(which I have assigned in my graduate course on psychological intervention
every year since it appeared; this semester I'm using his expanded
1997 edition.)
-- Jerry Davison
From: Pio Scilligo
Here are some of the books that have had an important influence on
me:
Wachtel, P. (1997). Psychoanalysis, behavior, and the relational
world. Washington: APA.
Lazarus, A. (1997). Brief
but comprehensive psychotherapy: The multimodal way. New York:
Springer
(and Lazarus's
1989 book)
Horowitz, M. J. (ed.) (1991). Person
schemas and maladaptive interpersonal patterns. Chicago: The
University of Chicago Press.
Benjamin, Lorna, S. (1996). Interpersonal
diagnosis and treatment of personality disorders. New
York: Guilford Press (especially her interpersonal model).
I am adopting all these volumes at the Graduate School for Clinical
Psychologists of the Salesian University in Rome and Horowitz at the
Second Graduate School of Clinical Psychology of the Unversity of
Rome "La Sapienza". Of course, books are just stimuli, they
are no substitute to the creativness of the psychotherapist!
Pio Scilligo, Ph. D.
Professor of Psychology
University of Rome "La Sapienza"
Faculty of Psychology
From: Graz Kowszun
I would like briefly to introduce myself before responding. I am a
humanistic integrative psychotherapist practicing in the unfashionable
south-easterly corner of London. My caseload is multi-cultural and
of diverse sexualities, and I offer both short-term contracts and
longer term opportunities. I have practiced as a counsellor and psyhotherapist
for some 15 years and was delighted when convergence between analytic
and humanistic schools began to take off, and integrative trainings
appeared in England:
I agree that live experiences more than books encouraged me to consider
integration. Nonetheless the goodies for me include:-
Kahn, M. (1991) Between
Therapist and Client, New York: W.H. Freeman
Erskine, R. & Moursand, J. (1988)
Integrative Psychotherapy in Action: Sage
Also an article:-
Erskine, Richard, G. (April, 1994) Shame and Self-Righteousness:
Transactional Analysis Perspectives and Clinical Interventions,
in Transactional Analysis Journal, Vol 24, No. 2.
Kepner, J. (1995) Healing
Tasks: Psychotherapy with Adult Survivors of Childhood Abuse,
San Francisco: Gestalt Institute of Cleveland
Kaufman, G. (1989)
The Psychology of Shame, London: Routledge.
Whitmore, D. (1991)
Psychosynthesis Counselling in Action, London: Sage
These are mainly practice based
examples of integrative models that include what is dear to me.
Recognising the impact of shame and how approaches to therapy can
humiliate rather than heal was a turning point in my understanding
and practice. Developing the sense of self (and a self operating
on interdependent levels)as an integrative tool means a lot to me
also.
A brilliant question / topic - could you please send the biblio
when it is collated?
Thanks and best wishes,
- -- Graz Kowszun
From: Stanley Messer
In addition to
Paul Wachtel's book, which was a key influence in my own work,
two other volumes come to mind. One is by Stephen Appelbaum, called
Out
in Inner Space: A Psychoanalyst Explores the New therapies.
It is his account of what he learned visiting centers where the new
therapies of the 70's (such as rolfing, biofeedback, bioenergetics,
macrobiotic dieting, transcendental meditation) were being practiced,
and what he could incorporate into psychoanalytic practice. The other
was Perry
London's book about the modes and morals of psychotherapy in which
he looked at the insight oriented and action-oriented therapies within
a broad, socicultural context.
Stanley Messer
From: "P. Abrego"
I'm beginning to see some of my favorite books appearing on this list.
I would like to add two more of Wachtel's books, Therapeutic
Communication (Guilford, l993) and Family Dynamics in Individual
Psychotherapy (Wachtel & Wachtel, l986). Also, I like Lorna
Benjamin's writings on interpersonal psychotherapy, Interpersonal
diagnosis and treatment of personality disorders (New York, l996)
and writings by Daniel Wile, After
the Fight (l993, Guilford) and After the Honeymoon (Wiley,l988)
for couples therapy. By way of introduction, I am a psychologist in
private practice in Seattle and am affiliated with the Univ. of WA.
I like this dialogue! Phil
From: "david gilbert"
I am struck that in this discussion very little influence has been
attributed to basic psychological science (e.g., learning, memory,
information processing, neuroscience, cognition, socail, recent work
on affect and cognitive-affective interactions). Modern psychological
science has offered me a great deal and provides conceptual frameworks
and heuristic guides for therapy integration. I find it useful to
look for common mechanisms of psychological and behavioral change
across therapies and in life and behavior in general. I believe that
basic science has a lot to offer clinicians if they bother to integrate
their theories within broader frameworks.
David Gilbert
From: Gerald Davison
Dear Dr. Gilbert,
Thank you for reminding me that an aspect of SEPI is, or should be
(in my view), a concern for linking therapeutic interventions with
basic psychological science. One way to do this is to work from principles
of change to innovative applications. This is the rhetoric of behavior
therapy, where my own primary identification lies. Another way is
to try to validate the efficacy and effectiveness of existing therapies
in controlled studies. This is reflected in the Empirically Supported
Treatments work of Division 12, recent information on which was just
posted on another network I am on.
The books mentioned as influential so far, including those I suggested,
are not particularly noted for their empirical underpinnings. Instead,
they reflect primarily the clinical impressions of creative clinicians,
and these too are important to advancing psychotherapy and encouraging
discussion and collaboration across school lines. But what has begun
to concern me about SEPI is that this is where the interests and energies
of most SEPI members seem exclusively to lie, or at least that is
how it appears to me.
As Arnold Lazarus and I have argued in a couple of recent publications,
advances in clinical work depend on both creative, heuristically fertile
hypotheses -- and I use the word "hypotheses" intentionally
-- and on systematic study that is informed by what we know in general
about human behavior in a more scientific sense than holds the interest
of many practicing clinicians.
All of which brings to mind O. H. Mowrer's two 1960 volumes on learning theory and clinically relevant speculations. I read these in graduate
school over thirty years ago and commend them to anyone who is interested
in how a brilliant experimental psychologist extrapolated from basic
S-R, mostly animal-based theory and research to proposals that can
enhance our understanding of complex human behavior, cognition, and
affect.
Cheers,
Jerry Davison
From: "Jerry
Gold"
The discussion about the relationship of psychological science to
practice reminded me that I've been heavily influenced by works such
as Ferster and Skinner's Schedules of Reinforcement, Mahoney's
Cognition and Behavior Modification, and the writings of Tolman,
Hull and Spence. Yet, these ideas don't spring to mind immediately
as clinical influences, but remain (dare I say it about such authors?)
unconscious influences (Or is it introjects?). Clinical writers tend
to influence me clinically, as does of course, clinical experience
and modeling of other experienced clinicians. This discussion is reminiscent
of some of Hans Strupp's views on the indirect relationship between
science and practice and also of George Stricker's publications on
the local clinical scientist.
George has a new book (with Steven Trierweiler) just out on this topic,
The
Scientific Practice of Professional Psychology.
I wonder if colleagues who came to SEPI from a psychodynamic background,
like myself, are less likely to look to basic psychological science
as a foundation?
Some other seminal writings:
Beier, The Silent Language of Psychotherapy (An integration
of Freud & Skinner);
Feather & Rhodes on Psychodynamic behavior therapy;
Franz Alexander on the Therapist as a reinforcer.
Jerry Gold
From: Paolo Migone
I would like to make briefly few comments about the "important
books" one has in mind on psychotherapy integration. I agree
on the importance of Wachtel's work (beside his books already mentioned
in the list, I refer, for example, to such contributions as his attempt
at linking Freud's concept of transference with Piaget's concept of
coreggible schemas).
But I would like to add that, to me, psychotherapy integration can
be only at the theoretical level. "Clinical" integration
is meaningless, because it does not exist, so to speak: when me try
to describe clinical interventions or approaches, we always do theory,
otherwise we could not even talk about what we do. We always use concepts.
It is for this reason that, for example, one of the books that I found
important is Lawrence Friedman's book "Anatomy of Psychotherapy"
(1988): the author tries to review and understand various approaches,
to see them historically, to compare them, to see how and why they
work, what are the premises, etc.
In my opinion it is at this level that "psychotherapy integration"
really makes sense.
Paolo Migone, M.D.
From: Hilde Rapp
I appreciate the contributions people are making towards constucting
a reading list of what's hot and helpful in psychotherapy integration
and I hope that the final product will be published in the Journal
for the benefit of those members who are not on email.
To add my penny's worth to the existing list which of course contains
some of my favorites already:
Roth, T. and Fonagy P. (1996) What Works for Whom, New York:
Guildford Press.
I find this a very sensitive and
sensible, tightly argued book which covers many of the debates stimulated
within Sepi about the need to meet client need through innovative
and hence integrative practice while at the same time endeavouring
to work in ways which are open to intellectual, ethical, scientific
and pragmatic scrutiny. Pages 44 onwards cover Sepi ( and SPR) territory
well, for instance.
Also, I want to add Marv Goldfried's
series "In Session" which addresses our need as busy clinicians
to form a quick overview of what has been reported to work for whom
in a clear and accessible way. From a UK perspective there is perhaps
a wish to see more European contributions, but maybe there need
to be different series for different service contexts.
M.R. Goldfried (Editor in Chief)In
Session. Psychotherapy in Practice.Published Quarterly by John Wiley
and Sons.
I also really like Susan Heitler's
description of psychotherapy integration as 'Fitting together the
Pieces of the Puzzle'. It's not a new book, but its modest style
is, to my mind, characteristic of the best of SEPI, especially where
she looks at the relationship between 'treatment focus', 'treatment
philosophy' and some relevant 'treatment techniques' in a simple
client or patient centred way ( pp190 ff, Bill Pinsoff,John Clarkin,
and Arnold Lazarus of course do the same thing within more tightly
formulated, and more highly articulated theoretical and methodological
frameworks, but I am supposing that most of us know that already...):
Heitler. S (1990) From Conflict to Resolution. Skill and Strategies
for Individual, Couple and Family Therapy.
Colin Feltham's (1997) Which Psychotherapy?Leading Exponents
Explain Their Differences. London: Sage, raises important
issues in the ever necessary debate about which approach, framework,
technique might not marry at all well with which other one and why,
because, at bottom, there are fundamental clashes between values.
REFLECTIONS
In a way, the books I like most ( and there could be lots of others
which there isn't room to mention) locate our need to integrate
different ways of thinking and working at the interface between
an individual therapist and an individual client ( family, group,
organisation) regarding a particular issue at a particular time.
As Saul Raw ( following Shakespeare's adage 'readiness is all'?)
maintains ( see latest issue of JIP), sensitive timing, and pacing,
and recognising the solution, which is at that moment within the
grasp and the resources of the client/therapist pair engaged in
a dialogic relationship, is the best we can ever hope to manage
in practice. It is a real boon if we can talk with colleagues about
what happened in those momemts where things moved on in intelligent
and intelligible ways. Better still if we can write about it so
that it helps all of to us to develop a shared language . This makes
it easier to recognise where we're headed, and to preview what we
might need to prepare for...
I am always looking for frameworks
which help me to formulate quite precise questions about how one
may flexibly combine differential therapeutics. I suppose the focus,
for instance by Jacquie Persons ( Cognitive Behavioural), Tony Ryle
( Cognitive Analytic), Peter Fonagy ( Psychoanalytic and Psychodynamic)
on labouring away to arrive at a reasonable, sensitive, clear, and
comprehensive formulation of the clients difficulties is the same
activity at the level of integrative practice as the one I am advocating
here at the level of conceptualising the field of psychotherapy
integration.
At this higher level, I expect
the construction of such frameworks to be underpinned by cumulated
observations and conceptual debates: Has the author wrestled with
such questions such as:> what do we collectively already know
about what values, objectives, aims, go together with what other
ones?> what have we collectively found out about what helps or
hinders (!!)whom in which context? or, as Marv puts it: do we know
anything about which therapist behaviours are most likely to facilitate
the beneficial workings of common therapeutic factors? On optimistic
days I think we know quite a lot, on bad days I wonder how much,
what we do know, actually helps me to stay with this client now...
Regards
Hilde
From: Mary Coombs
I have enjoyed reading what others are interested in and recommended
readings. To introduce myself, although my background has been predominantly
clinical, I am currently doing post-doctoral work at U. of Ca. - Berkeley
in mental health research. One of the areas that I have been working
on is that of the role of emotion in psychotherapeutic change, and
am looking in depth at the various major schools of psychotherapy,
including research, theory, and clinical practice and their distinctive
views of emotion, its etiology, purpose, and how it relates to psychotherapeutic
change. I am particularly interested in the contrast between the psychodynamic,
cognitive and behavioral approaches and their handling of the element
of client emotion. In my review of the existing measures of emotion
in psychotherapy, I am struck by the fact that existing measures of
emotion in psychotherapy (i.e. the Experiencing Scale (M. Klein
et al.), Wilma Bucci's Referential Analysis, Enrico Jones'
Psychotherapy Process Q-sort) are orthogonal in certain research
studies and find that this raises very interesting questions about
what actual aspect of emotion in sessions is being measured, and how
experienced clinician/researchers can view the same case in opposite
ways in terms of what is considered to be positive psychotherapeutic
change with respect to client emotion. Grist for the mill. In this
regard, I would add to the list of helpful integrative material, some
of the works by Leslie Greenberg (such as Greenberg and Paivio (1997)
Working with Emotions in Psychotherapy and Greenberg (1993)
" Emotion and Change Processes in Psychotherapy"
in Handbook of Emotions edited by Michael Lewis and Jeannette
Haviland). These works make a major contribution, in bringing the
focus of emotion more clearly into the examination of psychotherapeutic
process. Greenberg's points about the different kinds of emotional
experiencing (i.e. what he refers to as "primary and "secondary"
emotion) offers a potential basis upon which to view psychodynamic
and cognitive/behavioral approaches to handling emotion in psychotherapy
and their potentially complementary contributions given that each
has superior methods for handling certain kinds of emotion. Lorna
Benjamin also has written a key piece about the therapeutic and counter-therapeutic
handling of client anger in sessions. Benjamin, L.S. (1990) "Interpersonal
analysis of the cathartic model" in Plutchik Robert, and
Henry Kellerman (Eds.) Emotion: Theory, Research, and Experience.
These writings offer a grounded and integrated look at multiple theoretical
perspectives on what occurs commonly before the eyes of the clinician.
A question I would like to see
tossed around is that of "eclectic" and "integrative"
psychotherapeutic approaches. Are they one and the same, or do these
terms have different meanings? I have heard some interesting arguments
about the impossibility of actually doing effective "eclectic"
psychotherapy (i.e. each major school is too complex, requiring
great skill etc. too much to mix and match--pick one and do it well
vs. eclectic (or integrative) is what really allows the therapist
to meet the patient where they are and to offer an effective intervention
as it is needed and as the psychotherapeutic process unfolds...).
Mary Coombs, Ph.D.
NIMH Post-doctoral Research Fellow
School of Social Welfare
120 Haviland Hall
University of California
Berkeley, CA 94720-7400
phone: 510- 643-6532
e-mail: coombs@uclink4.berkeley.edu
From: ABOHART@DHVX20.CSUDH.EDU
I was going to send my own comments
on the things that influenced me the most anyway, but they dovetailed
with the recent comment by Mary Coombs on emotion, and that finally
mobilized me to take keyboard in hand. My biggest influences were
not in psychology, but in philosophy and literature: the writings
of the existential philosophers, and writers like James Joyce and
Lawrence Durrell, both of whom created "integrative models"
in literature, models which continue to influence me. Within psychology,
the single most influential thing I ever read was Eugene Gendlin's
article "The experiential response" in a 1968 book
edited by Emmanual Hammer called Use of Interpretation in Treatment.
That article quite literally turned me into a good therapist overnight
(the next day I had a session; my supervisor was watching through
a one-way mirror and told me afterwards: "You've finally got
it!"). Furthermore it a) made sense for me of Carl Rogers'
formulations, which up to that point had seemed too nebulous to
be helpful (what do you do while you're being warm, empathic, and
genuine?), and b) provided the first integrative model in psychology
for doing therapy that I was aware of. Basically Gendlin (there
and in subsequent writings) argued that can use any intervention
or any idea from any therapy if it is tuned to the "experiential
track" of the client in the moment, and he then and since has
continued to argue that we should try to accumulate good ideas from
all approaches to use.
Which brings me to Mary Coombs'
interest in emotion. She notes that measures of "emotion"
are orthogonal, and includes in that the Experiencing Scale. But
it is no surprise that the Experiencing Scale may be orthogonal
to other measures of emotion because it is NOT a measure of emotion!
The experiencing scale is based on Gendlin's work, and Gendlin carefully
distinguishes between experiencing and emotion. Experiencing has
an affective component, but is more a meaning-making process. The
problem is that it is not a meaning-making process in our typical
western cognitivist way of looking at things. Rather, it is not
dealing with "ideas" and "beliefs," but rather
"bodily felt meaning", closer to what cognitive scientists
such as Lakoff and Johnson describe as the basis of all knowing:
preconceptual bodily experience. In fact, the experiencing scale,
congruent with this, correlates more highly with cognitive measures
than with affective measures (at least in some studies). As I tried
to clarify in my 1993 Journal of Psychotherapy Integration article,
our theories tend to dichotomize the world into Cognition and Emotion,
and then have a hard time classifying experiencing, which kind of
lies in between. In any case, I salute Mary's interest in clarifying
what it means to say that something is an emotion.
Art Bohart
Department of Psychology
California State University Dominguez Hills
Carson, CA 90747
From: Hilde Rapp wrote:
Dear Sepi online colleagues
I really appreciate Gerald Davidson's reminding us of the importance
of taking account of research in general psychology. I would add sociology
and anthropology as well. In many ways, therapeutic approaches which
aim to repair earlier damage or which aim to make up environmental
deficits must base their interventions on what practitioners would
normally help people to achieve certain developmental tasks throughout
the life span. Increasingly we can back up these beliefs with findings
from research into normal social, cognitive and emotional developmental
processes.Both research outcomes and paradigms relevant to infant-
parent atunenement and attachment ( cf Wilma Bucci) are informing
psychoanalytic theories about the therapeutic relationship between
the therapist/analyst and the adult client/patient. Similarly, Gerald
Davison might agree, cognitive behavioural approaches are more or
less constructed on the back of research into learning, memory and
skill aquisition.(Incidentally, this makes these therapies particularly
amenable to process and outcome research, because there is not really
any paradigm clash).
I also want to respond to Mary
Coombs contribution, which I think points us to the importance of
looking for integrative themes along particular axes of enquiry:
In Mary's case this axis co-ordinates the different ways in which
different approaches and researchers like Lorna Benjamin, Enrico
Jones, Leslie Greenberg, etc, construct concepts of emotion, and
hence diferrences in how the importance of particilar emotions in
the genesis and treatment of psychological difficulties is theorised,
and how technical approaches follow from that. What I find exciting
is the increasing specificity in our enquiries, looking quite precisely
and minuteltely at which differences and which similarities might
matter in relation to what issues. So, the orthogonality of certain
kinds of emotions is interesting in this regard. (There is also
some relevant work, for instance by Charles Spielberger in Florida
and by Stephen Palmer in the UK).
Wouldn't it make an exciting panel
plus co-ordinated workshop at a future sepi conference to get these
colleagues together to compare and contrast their concepts and methodologies?!
Also, the perennial question raised
by you, Mary (Coombs) as well as by other contributors to this 'poly'-logue,
concerning the difference between integration and eclecticism could
perhaps be asked more pointedly if we look to philosophy. Perhaps
we could argue that integrative approaches are constructed along
lines of enquiry where a particular 'pattern that connects' (to
quote Bateson), allied to certain fundamental values and models
of (wo)man inform the theoretical perspective as well as a set of
compatible practices?
> Integration vs Eclecticism
At the same time, there probably are 'problems' for which such a
sustained alignment is not necessary and an ad hoc 'eclectic' combination
of ways of achieving a particular objective are the optimal fast
and flexible response? But, perhaps even within an integrated approach
we may need to preserve the freedom to be innovative by making ad
hoc choices with particular clients at particular times...? I believe,
incidentally that contemporary work in philosophy , especially philosophy
of mind,language, science, ethics and aesthetics is grappling with
questions which are highly relevant to our work. Perhaps we could
learn from, and we should contribute, more fully to these discourses?
Thank you Jerry and Carrol, for
making this free flowing sharing of thoughts, questions and exchanges of experience possible.
Hilde Rapp
( Chair, British Institute of Integrative Psychotherapy, Network
co-ordinator, SEPI, UK )
21 Priory Terrace
London NW6 4DG
Tel 44 (0)171 625 4287
Fax 44 (0)171 813 4718
email: rapp.biip@cableinet.co.uk
From: "J. Russell Ramsay"
Greetings to all,
First, to introduce myself, I am
a psychologist with the Center for Cognitive Therapy of the University
of Pennsylvania. I completed a two-year postdoctoral fellowship
before being named clinical director of the Center's first satellite
office, which is located in Bucks County, PA. I am active in clinical
service, supervision of postdocs, and writing/research.
Second, I'd like to offer a short
list of books I found to be influential. First is Mahoney's (1991)
"Human Change Processes" for his coherent integration
of a vast amount of scientific literature regarding behavior, personal
meaning-making, and change processes. This book, along with a special
issue of the Journal of Clinical and Consulting Psychology (1993)
devoted to cognitive and constructivist therapises solidified my
then growing interest in the congruence of these two models. Wegner
and Pennebaker's (Eds., 1993) "Handbook of Mental Control"
is an interesting collection of contributions regarding various
aspect of human experience, cognitive/emotional processing and how
we "make sense" of things. Finally, the "Evolution
of Psychotherapy" series (Zeig, Ed., 1987, 1992, 1997)
provides a forum to listen in as master clinicians share with one
another their theories, practices, and meta-frameworks. In striving
to provide empirically-supported treatment, I find it vital to integrate
transtheoretical phenomena such as learned helplessness, social
learning, social psychology, emotional intelligence, cognitive heuristics,
etc.
Sincerely,
Russ Ramsay
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